Comparison of a Novel Real-World Speech in Noise Auditory Attention Task to Standard Clinical Audiological Metrics

Pure tone audiometry (PTA) remains the clinical standard for evaluating hearing ability, yet individuals with similar audiometric profiles often exhibit substantial variability in their capacity to understand speech in everyday listening environments. Growing evidence suggests this variance is related to contributions from cognitive ability and auditory processing that standard threshold measures do not capture. To investigate how PTA, cognitive factors, and demographics such as age jointly predict real-world speech perception, 116 veteran adults 20-70 years old spanning a range of normal to moderate sensorineural hearing losses completed a spatial auditory attention task. Target color words were embedded within naturalistic short-story narratives presented under two conditions: a mono-talker speech-in-quiet (SIQ) condition and a dual-talker speech-in-noise (SIN) condition with a spatially separated competing narrative. Behavioral performance was quantified via color word hit accuracy, reaction time, and comprehension question accuracy. Participants also completed pure tone audiometry, the Montreal Cognitive Assessment (MoCA), and the Speech, Spatial and Qualities of Hearing Scale (SSQ12). Mixed-effects regression models were used to evaluate the contributions of PTA, age, cognitive ability, and self-reported hearing difficulty (SSQ12) to task performance across conditions. Results demonstrate a complex interplay between age, PTA, MoCA, and/or listening condition (SIQ vs. SIN) in predicting identification accuracy, reaction time, and comprehension. Age and condition significantly predicted hit accuracy and reaction time, with older participants showing improved accuracy in quiet but declining accuracy and slower responses in noise. PTA did not emerge as a significant main effect predictor but interacted with cognitive ability and condition to modulate performance, in some cases exhibiting a paradoxical inverse relationship with accuracy dependent on MoCA score. MoCA scores significantly predicted comprehension across conditions, and SIN hit accuracy was positively correlated with SSQ12 scores, validating the task against participants’ real-world listening experiences. These findings highlight the importance of incorporating cognitive screening and ecologically valid speech perception tasks into audiological assessment to better identify individuals at risk for functional hearing impairment in complex listening environments.